1. United States Fire Administration Chief Officer Training Curriculum Operations Module 4: ICS for EMS

2. United States Fire Administration Ops 4-2 Objectives  Identify positions and responsibilities in the ICS organization for EMS incidents  Identify elements of S.T.A.R.T.  Identify potential problems for an EMS incident  Identify resource needs at EMS incidents  Develop a command and organizational structure at an EMS incident

3. United States Fire Administration Ops 4-3 Overview  Who is in charge at EMS incidents?  Roles and responsibilities of the IC, division/group leaders, and unit leaders  S.T.A.R.T. system  Basic and expanded ICS organization for EMS incidents  Multicasualty ICS branch at EMS incidents

4. United States Fire Administration Ops 4-4 Benefits of an ICS at EMS Incidents  Controls, organizes, and directs responders  Provides common terminology and position titles  Provides chain of command  Groups common functions and responsibilities

5. United States Fire Administration Ops 4-5 Benefits of an ICS at EMS Incidents (continued)  Provides for responder accountability and safety  Provides for accurate patient accountability and structure to deliver appropriate care  Provides for efficient use of regional resources (hospitals, transports, trauma centers, etc.)

6. United States Fire Administration Ops 4-6 Levels of EMS Incidents  Often defined by local guidelines  Multiple casualty incident: –May have minimal number of casualties but unusual events –May hinder normal operations at local hospitals –May draw down system resources, or number of patients outnumbers resources or rescuers

7. United States Fire Administration Ops 4-7 WHO IS IN CHARGE AT EMS INCIDENTS ?

8. United States Fire Administration Ops 4-8 Role and Responsibilities of the IC  Ensures life safety of responders and citizens  Determines objectives and strategies, sets immediate priorities  Determines/approves tactical objectives  Establishes an Incident Command Post (ICP)

9. United States Fire Administration Ops 4-9 Role and Responsibilities of the IC (continued)  Coordinates activities of assigned staff  Authorizes release of information to the news media  Establishes an ICS organization to meet incident needs, both current and projected

10. United States Fire Administration Ops 4-10 IncidentCommander Initial Response Basic Organization

11. United States Fire Administration Ops 4-11 Incident Commander Rescue/ Extrication Group Rescue/Extrication Group Supervisor

12. United States Fire Administration Ops 4-12 Rescue/Extrication Group Supervisor (continued)  Implements assigned incident objectives  Provides tactical direction and supervision to assigned resources  Determines resources needed to extricate patients  Communicates resource requirements to IC as necessary  Ensures safety of members operating in area

13. United States Fire Administration Ops 4-13 Rescue/Extrication Group Supervisor (continued)  Coordinates with treatment unit leader for patient care during rescue operation  Ensures efficacy of rescue/extrication operations  Coordinates patient transportation to triage area  Provides frequent progress reports to IC  Maintains incident documentation

14. United States Fire Administration Ops 4-14 Rescue/ Extrication Group IncidentCommander MedicalGroup Medical Group Supervisor

15. United States Fire Administration Ops 4-15 Medical Group Supervisor (continued)  Implements assigned incident objectives  Participates in multicasualty branch/operations section planning  Establishes medical group/division  Requests additional personnel and resources  Designates unit leaders and treatment areas

16. United States Fire Administration Ops 4-16 Medical Group Supervisor (continued)  Isolates morgue and minor treatment from immediate and delayed treatment areas  Requests law enforcement/coroner involvement  Establishes communication and coordination with transportation  Ensures activation of hospital alert system

17. United States Fire Administration Ops 4-17 Medical Group Supervisor (continued)  Directs on-scene personnel such as Red Cross, coroner, medical teams  Ensures safety and security of treatment and morgue areas  Directs medically trained personnel to appropriate unit leader  Maintains incident documentation

18. United States Fire Administration Ops 4-18 IncidentCommander Rescue/ Extrication Group MedicalGroup TriageUnit Triage Unit Leader

19. United States Fire Administration Ops 4-19 Triage Unit Leader (continued)  Determines location of triage area(s)  Ensures all patients assessed and sorted in accordance with appropriate triage protocols  Determines resources required for triage operations

20. United States Fire Administration Ops 4-20 Triage Unit Leader (continued)  Communicates resource requirements to medical group supervisor as necessary  Develops triage organization sufficient to handle assignment  Ensures safety and security of all members operating in area  Ensures efficacy of triage operations

21. United States Fire Administration Ops 4-21  Provides frequent progress reports to medical group supervisor  Establishes initial morgue operations  Coordinates movement of patients from triage area to treatment area  Maintains incident documentation Triage Unit Leader (continued)

22. United States Fire Administration Ops 4-22 S.T.A.R.T.  Uses vital signs instead of mechanism of injury  Takes less medical expertise  Uses basic vital signs  Uses standard triage tags

23. United States Fire Administration Ops 4-23 Triage Tags

24. United States Fire Administration Ops 4-24 S.T.A.R.T. (continued) Algorithm  Assess ventilation  Assess perfusion  Assess mental status

25. United States Fire Administration Ops 4-25 IncidentCommander Rescue/ Extrication Group MedicalGroup TriageUnitTreatmentUnit Treatment Unit Leader

26. United States Fire Administration Ops 4-26 Treatment Unit Leader (continued)  Identifies and establishes suitable area(s) for treatment operations  Identifies and requests additional resources as needed  Coordinates with triage unit leader the movement of patients from the triage area to treatment area(s)  Receives patients in the treatment area

27. United States Fire Administration Ops 4-27 Treatment Unit Leader (continued)  Establishes communication and coordination with patient transportation group supervisor  Assigns, supervises, and coordinates personnel within the area(s)  Ensures safety of members operating in area

28. United States Fire Administration Ops 4-28  Ensures efficacy of treatment operations  Directs movement of patients to ambulance loading area  Provides frequent progress reports to the medical group supervisor  Maintains incident documentation Treatment Unit Leader (continued)

29. United States Fire Administration Ops 4-29 IncidentCommander Rescue/ Extrication Group MedicalGroupPatientTransportationGroup TriageUnitTreatmentUnit Transportation Group Supervisor

30. United States Fire Administration Ops 4-30 Transportation Group Supervisor (continued)  Establishes adequately sized, easily identifiable patient loading area  Establishes communication with area hospitals  Designates ambulance staging area  Identifies and requests additional resources

31. United States Fire Administration Ops 4-31 Transportation Group Supervisor (continued)  Directs transportation of patients in coordination with treatment unit leader  Requests air and ground ambulance  Coordinates air ambulance transportation  Establishes air ambulance helispot(s)  Maintains patient tracking records

32. United States Fire Administration Ops 4-32 IncidentCommander Rescue/ Extrication Group MedicalGroupPatientTransportationGroup TriageUnitTreatmentUnit Basic Organization

33. Incident Command Treatment Medical Group Rescue/ Extrication Group Patient Transportation Group Triage

34. Staging Area Manager Incident Command Helibase Manager Treatment Medical Group Rescue/ Extrication Group Patient Transportation Group Triage

35. United States Fire Administration Ops 4-35 Staging Area Manager Assembles, coordinates, and controls resources assigned to staging  Ensures unimpeded access to and egress from staging area  Establishes an accurate inventory system for all responding units  Provides routing instructions for resource assignments

36. United States Fire Administration Ops 4-36 Staging Area Manager (continued)  Requests maintenance services for staged resources as needed  Safeguards staging  Determines required reserve level(s) for assigned resources  Advises operations section chief when resource at or near minimum reserve level

37. United States Fire Administration Ops 4-37  Coordinates access to EMS vehicles with ground ambulance coordinator  Ensures safety of members operating in the staging area  Evaluates staging area operations for efficacy  Provides frequent progress reports Staging Area Manager (continued)

38. United States Fire Administration Ops 4-38 Helibase Manager  Locates safe and adequately sized Landing Zone (L/Z)  Advises command and the transportation officer of L/Z location  Ensures L/Z site safety  Maintains communications with helicopters

39. United States Fire Administration Ops 4-39 Helibase Manager (continued)  Secures safe routes for ground ambulances entering and exiting the L/Z  Requests and supervises resources as needed  Maintains incident documentation

40. Medical Group Medical Group Patient Transportation Group Patient Transportation Group Staging Area Manager Staging Area Manager Operations Section Operations Section Triage Unit Treatment Unit Immediate Treatment Manager Immediate Treatment Manager Delayed Treatment Manager Delayed Treatment Manager Minor Treatment Manager Minor Treatment Manager Triage Personnel

41. United States Fire Administration Ops 4-41 Treatment Team Managers  Request and assign resources for patient needs  Ensure continuous triage of patients in area  Prioritize patients for transport  Coordinate and notify treatment dispatch manager of readiness and priority of patients for transport  Ensure patient information documented

42. United States Fire Administration Ops 4-42 Treatment Dispatch Manager  Establish and maintain communications with treatment managers and medical communications coordinator  Verify with treatment managers any special transport needs  Assure tracking of patient information

43. United States Fire Administration Ops 4-43 Medical Supply Coordinator  Responsible for procuring, maintaining, and distributing medical supplies  In fully expanded ICS, communicates with logistics section—supply unit leader

44. United States Fire Administration Ops 4-44 Morgue Manager  Coordinates activity with law enforcement  Identifies and secures suitable area for morgue  Coordinates with medical examiner regarding removal of deceased  Ensures completion of all documents related to deceased

45. United States Fire Administration Ops 4-45 Morgue Manager (continued)  Ensures safety of members operating in area  Communicates progress reports to IC as required  Keeps identity of deceased confidential  Maintains appropriated incident documentation

46. Lines of communications Helibase Manager Patient Transportation Group Supervisor Medical Group/Division Supervisor Rescue/Extrication Group Operations Section Operations Section Staging Triage UnitTreatment Unit Treatment Dispatch Manager Treatment Teams Medical Supply Coordinator Medical Communications Coordinator Ground Ambulance Coordinator Air Ambulance Coordinator Morgue Manager

47. United States Fire Administration Ops 4-47 Medical Communications Coordinator (continued)  Establish and maintain communications with medical facilities or local medical resource control point  Maintain current status of medical facility availability  Coordinate with treatment dispatch manager and ambulance coordinators  Coordinate off-incident patient destinations  Maintain appropriate incident documents

48. United States Fire Administration Ops 4-48 Air/Ground Ambulance Coordinators  Establish ambulance staging area and log units in and out as assigned  Coordinate with helibase manager or air operations branch director  Establish and maintain communications with medical communications coordinator and treatment dispatch manager  Provide ambulance resources

49. United States Fire Administration Ops 4-49 Air/Ground Ambulance Coordinators (continued)  Provide inventory of medical supplies available at ambulance staging area  Assure necessary equipment available in ambulances  Establish contact with ambulance agencies at scene  Request additional resources  Maintain incident documentation

50. United States Fire Administration Ops 4-50 Activity 4.1: Liberty County Vehicle Accident

51. United States Fire Administration Ops 4-51 Scenario: Basic Information  TIME: 2000 hours  DATE: January 20  WEATHER: 45 degrees, winds from SSE @ 5 to 10 knots, overcast skies

52. United States Fire Administration Ops 4-52 2000 Hours Liberty communications to:  Liberty Engine 203  Central Truck 101  Liberty Battalion 1  LifeLine 22  Liberty County Sheriff's Units Reported traffic accident at the intersection of State Route 52 and East Lake. Possible people trapped.

53. United States Fire Administration Ops 4-53 2003 Hours Able Flight 1 to Liberty Communications:  Currently over the East Lake accident. Appears to be a minimum of three vehicles. Two vehicles over the side. One appears to be a large vehicle. We will try to get a closer look. Liberty Battalion 1 to Liberty Communications:  Copy Able’s traffic—multiple vehicles

54. United States Fire Administration Ops 4-54 2004 Hours Able Flight 1 to Liberty Communications:  Confirmed three vehicles. Two over the side. One appears to be a bus. The other two sedans. Liberty Engine 203 to Liberty Communications:  Engine 203 on scene; stand by for report on conditions.

55. United States Fire Administration Ops 4-55 2005 Hours Liberty Engine 203 to Liberty Communications:  Three vehicles involved. Multiple victims trapped inside an overturned bus which is off the road and down an embankment 25 feet. Appear to be at least 15 victims.  Assuming Lake Command LifeLine 22 to Liberty Communications:  On scene

56. United States Fire Administration Ops 4-56 2007 Hours Lake Command to Liberty Communications:  This will be a mass-casualty incident. Triage in progress. Request an MCI response per Liberty County EMS plan. Liberty Communications to Lake Command:  Copy MCI response—prepare to copy resources  Liberty Battalion 1 Copies

57. United States Fire Administration Ops 4-57 2007 Hours (continued) Central Truck 101 to Liberty Communications:  On scene Liberty Battalion 1 to Liberty Communications:  On scene assuming; Lake Command

58. United States Fire Administration Ops 4-58 2008 Hours Liberty Communications to Lake Command:  Copy Liberty Battalion 1 now Lake Command  Stand by to copy the MCI response  Liberty Chief has been notified and is responding—ETA 20 minutes.

59. United States Fire Administration Ops 4-59 2009 Hours Liberty Communications to Lake Command:  MCI response and ETA’s are  Liberty Battalion: 2 to 5 minutes  Liberty Engine 201: 6 minutes  Liberty Engine 202: 6 minutes  Liberty Engine 205: 7 minutes  Central Truck 102: 8 minutes W/3  Central Mass-Casualty: 8 minutes W/1

60. United States Fire Administration Ops 4-60 2009 Hours (continued)  Medflight 1: 8 minutes  Medflight 2: 16 minutes  LifeLine 21: 5 minutes  LifeLine 24: 5 minutes  LifeLine 25: 8 minutes  Community 31: 6 minutes  Community 33: 8 minutes  Community 34: 9 minutes  Central Medic 101: 7 minutes  Central Medic 103: 9 minutes  Central Medic 106: 10 minutes

61. United States Fire Administration Ops 4-61 2010 Hours Triage to Lake Command:  There is a total of 30 patients. Triage report is being brought to the Command Post at this time.  At least 10 patients will require extensive extrication work. At least 2 hours to free all patients.  The bus appears stable. No fuel leak detected at this time. Second vehicle stable with fuel leak. One DOA.

62. United States Fire Administration Ops 4-62 Module Summary  Basic ICS organization at EMS incidents  Expanded ICS organization at ICS incidents  Multicasualty Branch at EMS incidents